Liu Yu,Liu Jiangang,Wang Junlu,et al.Application of intraoperative flash visual evoked potential monitoring in children with sellar region tumors[J].Journal of Clinical Pediatric Surgery,,21():911-916.[doi:10.3760/cma.j.cn101785-202205044-003]
Application of intraoperative flash visual evoked potential monitoring in children with sellar region tumors
- Keywords:
- Brain Neoplasms; Neurosurgical Procedures; Neurophysiological Monitoring; Flash Visual Evoked Potential; Treatment Outcome; Child
- Abstract:
- Objective To explore the application value of flash visual evoked potential (F-VEP) monitoring during operations of sellar region tumors in children.Methods From January 2020 to December 2021,clinical data were retrospectively reviewed for 20 hospitalized children undergoing operations for sellar region tumors.They were divided into two age groups of 1-6-year and 7-14-year (n=10 each).Tumor resection was performed under intravenous plus inhalation anesthesia and F-VEP monitoring intraoperatively.The amplitudes of F-VEP under different leads and different stimulation frequencies (0.7-2.0 Hz) were compared to determine the appropriate stimulation parameters and major observation parameters.Visual acuity was examined at Day 14 post-operation for examining the correlation between intraoperative observation parameters and postoperative visual acuity.Results In 1-6-year group,at a stimulation frequency of (1.4 Hz),the amplitude between N75-P100(A1) or N145-P100(A2) of three leads (O1-Fz,O2-Fz,Oz-Fz) were higher than any other frequency (0.7,1.0,2.0 Hz)(all P<0.05).As compared between different leads,the amplitude of A1/A2 at lead O2-Fz or Oz-Fz were higher than those at lead O1-Fz (P<0.05).At any lead,the amplitude of A2 was higher than that of A1 (P<0.05).In 7-14-year group,at a stimulation frequency of (0.7 Hz),the amplitude of A1/A2 of all three leads were higher than any other frequency (1.0,1.4,2.0 Hz)(all P<0.05).As compared between different leads,amplitude of A1/A2 at lead O2-Fz or Oz-Fz were higher than those at lead O1-Fz (P<0.05).At any lead,amplitude of A2 was higher than that of A1 (P<0.05).F-VEP amplitude was higher than baseline (n=3) and postoperative visual acuity improved as compared with preoperatively.In 8 cases without change in waveform,there were improved postoperative visual acuity (n=2) and no improvement (n=6).The waveforms of 6 cases showed reversible changes of initial decline and subsequent rise.Visual acuity improved (n=3) and showed no obvious changes (n=3).In 2/3 of cases with a declining waveform during operation,amplitude declined by <50% and no obvious change occurred in postoperative visual acuity.In another case,amplitude declined by >50% and postoperative visual acuity decreased.Conclusion Appropriate electrophysiological stimulation parameters may be selected according to patient age so that stable F-VEP waveform appears during sellar tumor surgery in children.Intraoperative F-VEP monitoring helps to avoid damage to visual pathway and has some clinical practical value for evaluating postoperative visual function.
References:
[1] Toyama K,Wanibuchi M,Honma T,et al.Effectiveness of intraoperative visual evoked potential in avoiding visual deterioration during endonasal transsphenoidal surgery for pituitary tumors[J].Neurosurg Rev,2020,43(1):177-183.DOI:10.1007/s10143-018-1024-3.
[2] Jellish WS,Leonetti JP,Buoy CM,et al.Facial nerve electromyographic monitoring to predict movement in patients titrated to a standard anesthetic depth[J].Anesth Analg,2009,109(2):551-558.DOI:10.1213/ane.0b013e3181ac0e18.
[3] Creel DJ.Visually evoked potentials[J].Handb Clin Neurol,2019,160:501-522.DOI:10.1016/B978-0-444-64032-1.00034-5.
[4] 中国医师协会神经外科分会神经电生理监测专家委员会.中国神经外科术中电生理监测规范(2017版)[J].中华医学杂志,2018,98(17):1283-1293.DOI:10.3760/cma.j.issn.0376-2491.2018.17.002.Expert Committee of Neurophysiology Monitoring,Branch of Neurosurgery,Chinese Medical Doctor Association.2017 Chinese Standard of Intraoperative Neurophysiological Monitoring during Neurosurgery[J].National Medical Journal of China,2018,98(17):1283-1293.DOI:10.3760/cma.j.issn.0376-2491.2018.17.002.
[5] Chen X,Wang Y,Zhang S,et al.Effects of stimulation frequency and stimulation waveform on steady-state visual evoked potentials using a computer monitor[J].J Neural Eng,2019,16(6):066007.DOI:10.1088/1741-2552/ab2b7d.
[6] Hayashi H,Kawaguchi M.Intraoperative monitoring of flash visual evoked potential under general anesthesia[J].Korean J Anesthesiol,2017,70(2):127-135.DOI:10.4097/kjae.2017.70.2.127.
[7] McDonald CG,Joffe CL,Barnet AB,et al.Abnormal flash visual evoked potentials in malnourished infants:an evaluation using principal component analysis[J].Clin Neurophysiol,2007,118(4):896-900.DOI:10.1016/j.clinph.2007.01.006.
[8] Nilsson J,Dahlgren J,Karlsson AK,et al.Normal visual evoked potentials in preschool children born small for gestational age[J].Acta Paediatr,2011,100(8):1092-1096.DOI:10.1111/j.1651-2227.2011.02211.x.
[9] Chayasirisobhon S,Gurbani S,Chai EE,et al.Evaluation of maturation and function of visual pathways in neonates:role of flash visual-evoked potentials revisited[J].Clin EEG Neurosci,2012,43(1):18-22.DOI:10.1177/1550059411429529.
[10] Odom JV,Bach M,Brigell M,et al.ISCEV standard for clinical visual evoked potentials:(2016 update)[J].Doc Ophthalmol,2016,133(1):1-9.DOI:10.1007/s10633-016-9553-y.
[11] 郭栋泽,樊星,马佳佳,等.闪光视觉诱发电位方法学分析及其在鞍区肿瘤术中监测的初步应用[J].中华神经外科杂志,2020,36(3):248-252.DOI:10.3760/cma.j.cn112050-20190929-00418.Guo DZ,Fan X,Ma JJ,et al.Methodological analysis of flash visual evoked potential and its preliminary application in intraoperative monitoring during operations of sellar region tumors[J].Chinese Journal of Neurosurgery,2020,36(3):248-252.DOI:10.3760/cma.j.cn112050-20190929-00418.
[12] Sato A.Interpretation of the causes of instability of flash visual evoked potentials in intraoperative monitoring and proposal of a recording method for reliable functional monitoring of visual evoked potentials using a light-emitting device[J].J Neurosurg,2016,125(4):888-897.DOI:10.3171/2015.10.JNS151228.
[13] Jashek-Ahmed F,Cabrilo I,Bal J,et al.Intraoperative monitoring of visual evoked potentials in patients undergoing transsphenoidal surgery for pituitary adenoma:a systematic review[J].BMC Neurol,2021,21(1):287.DOI:10.1186/s12883-021-02315-4.
[14] Kodama K,Goto T,Sato A,et al.Standard and limitation of intraoperative monitoring of the visual evoked potential[J].Acta Neurochir (Wien),2010,152(4):643-648.DOI:10.1007/s00701-010-0600-2.
[15] Kamio Y,Sakai N,Sameshima T,et al.Usefulness of intraoperative monitoring of visual evoked potentials in transsphenoidal surgery[J].Neurol Med Chir (Tokyo),2014,54(8):606-611.DOI:10.2176/nmc.oa.2014-0023.
[16] 马佳佳,张晴,陆瑜,等.全身麻醉下视觉诱发电位在垂体腺瘤切除术中的应用价值[J].中华神经外科杂志,2021,37(8):820-824.DOI:10.3760/cma.j.cn112050-20210707-00336.Ma JJ,Zhang Q,Lu Y,et al.Application value of visual evoked potential in pituitary adenoma resection under general anesthesia[J].Chinese Journal of Neurosurgery,2021,37(8):820-824.DOI:10.3760/cma.j.cn112050-20210707-00336.
[17] Gutzwiller EM,Cabrilo I,Radovanovic I,et al.Intraoperative monitoring with visual evoked potentials for brain surgeries[J].J Neurosurg,2018,130(2):654-660.DOI:10.3171/2017.8.JNS171168.
[18] 戴定坤,杨丽,孟欢欢,等.不同部位损伤致视力障碍的视觉诱发电位特征[J].法医学杂志,2021,37(5):632-638.DOI:10.12116/j.issn.1004-5619.2020.201004.Dai DK,Yang L,Meng HH,et al.Characteristics of visual evoked potential in different parts of visual impairment[J].Journal of Forensic Medicine,2021,37(5):632-638.DOI:10.12116/j.issn.1004-5619.2020.201004.
[19] Qiao N,Song M,Ye Z,et al.Deep learning for automatically visual evoked potential classification during surgical decompression of sellar region tumors[J].Transl Vis Sci Technol,2019,8(6):21.DOI:10.1167/tvst.8.6.21.
[20] Houlden DA,Turgeon CA,Amyot NS,et al.Intraoperative flash visual evoked potential recording and relationship to visual outcome[J].Can J Neurol Sci,2019,46(3):295-302.DOI:10.1017/cjn.2019.4.
[21] Nishimura F,Wajima D,Park YS,et al.Efficacy of the visual evoked potential monitoring in endoscopic transnasal transsphenoidal surgery as a real-time visual function[J].Neurol India,2018,66(4):1075-1080.DOI:10.4103/0028-3886.236963.
Memo
收稿日期:2022-5-12。
基金项目:上海申康医院发展中心临床研究关键项目(SHDC2020CR5004)
通讯作者:肖波,Email:xiao977@hotmail.com